HB 961: Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide

Currently, Georgia's Surprise Billing Consumer Protection Act (O.C.G.A. Chapter 20E of Title 33) does not guarantee coverage for ground ambulance transportation, meaning patients could be billed directly by out-of-network ambulance providers. This bill rewrites Code Section 33-20E-23 to change that. Under the bill, a health plan must treat emergency ambulance transport as a covered service when a first responder or medical practitioner requests it, or when the transport was medically necessary. If there is no local government contract setting a reimbursement rate, insurers must pay out-of-network ambulance providers at least 300 percent of the Medicare reimbursement rate. Patients would only owe their normal copayment, coinsurance, or deductible, capped at what they would pay for an in-network ambulance. Insurers must pay clean claims within 30 days or explain any denial or request more information within that time.

• Requires Georgia health plans to cover emergency ground ambulance transportation requested by a first responder, medical practitioner, or when medically necessary.
• Sets a minimum reimbursement rate for out-of-network ambulance providers, defaulting to 300 percent of the Medicare rate when no local government contract sets a different rate.
• Caps what patients pay in copayments, coinsurance, or deductibles for out-of-network ambulance service at the same level as in-network service.
• Bars insurers from billing patients further once they pay the ambulance provider, aside from normal copays, coinsurance, or deductibles.
• Requires insurers to pay a clean (properly documented) claim within 30 days or send written notice of denial or a request for more information within that time.
• Defines key terms including ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity.

Georgians who use emergency ground ambulance services, health insurers and health plans operating in the state, ambulance providers (including local government-run ambulance agencies), first responders such as firefighters, paramedics, EMTs, and police, and county and municipal governments that may set local reimbursement rates by ordinance.

Patients who call or need an out-of-network ambulance would be protected from large surprise bills, since insurers would have to pay ambulance providers directly at a guaranteed minimum rate and patients would only owe normal cost-sharing amounts, similar to what they'd pay for an in-network ambulance ride.

• Section 1 rewrites O.C.G.A. § 33-20E-23, replacing language that left ground ambulance costs entirely to the patient's financial responsibility.
• Subsection (a) defines ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity for purposes of this Code section.
• Subsection (b) requires health plans to treat emergency ambulance transport as covered when requested by a first responder or practitioner, or when medically necessary.
• Subsection (c) sets the minimum reimbursement rate: a local government-negotiated rate if one exists, otherwise 300 percent of the Medicare Part A or B rate for ambulance services.
• Subsection (d) states that once an insurer pays the ambulance provider, the patient owes nothing further except normal copayments, coinsurance, or deductibles.
• Subsection (e) caps out-of-network ambulance copayments, coinsurance, or deductibles at the same level charged for in-network ambulance service.
• Subsection (f) requires insurers to pay clean claims within 30 days or, for incomplete claims, notify the ambulance provider within 30 days of a denial or request for more information.
• Section 2 repeals conflicting laws.

1. 2026-03-06Senate Read and Referred (Senado)
2. 2026-03-04House Passed/Adopted By Substitute (Cámara de Representantes)
3. 2026-03-04House Third Readers (Cámara de Representantes)
4. 2026-02-24House Committee Favorably Reported By Substitute (Cámara de Representantes)
5. 2026-01-16House Second Readers (Cámara de Representantes)
6. 2026-01-15House First Readers (Cámara de Representantes)
7. 2026-01-14House Hopper (Cámara de Representantes)

• Alan Powell (R, HD-033)Patrocinador principal
• Michelle Au (D, HD-050)
• Rick Jasperse (R, HD-011)
• Mary Oliver (D, HD-084)
• Sharon Cooper (R, HD-045)
• David Wilkerson (D, HD-038)

1. AprobadaVotación: Cámara de Representantes4 de marzo de 2026

   174 a favor, 1 en contra (1 sin votar, 1 ausentes)

   Passage: House Vote #611

• surprise billing
• ambulance services
• health insurance coverage
• medical billing protections
• emergency medical services